Douglas Alexander: Not least because my hon. Friend and I have adjacent constituencies, I fully appreciate the difference in climates between west Renfrewshire and the Caribbean, particularly at this time of year. I therefore take his point. We do not believe that sanctions offer the most effective means of promoting the transition to a pluralist democracy in Cuba, and I assure him that we make known our objections against the United States embargo every year at the United Nations. Indeed, on 28 October 2004, we again voted to adopt the resolution on the necessity of ending the economic, commercial and financial embargo imposed by the United States against Cuba.

Graham Allen: I hope that my right hon. Friend the Foreign Secretary will feel that there is no more important task on his agenda over the next year or so than trying to ensure, while not going over old ground, that we do not repeat any of the problems that the legality of action against previous tyrannies brought before the world and, indeed, this House. Will he accept that there is now an opportunity, given events in the last two or three weeks, to make real progress on developing a global legal system that will allow all of us to unite when faced with tyrannies and recreate the global coalition against terrorism on a sound legal basis?

Jack Straw: I do not accept the hyperbolic phrases used by the right hon. and learned Gentleman. Circumstances have changed since 1989, when the embargo was imposed. In any event, its scope is limited and it has no legal force.
	A key circumstance has changed during the intervening period. Following an initiative by my predecessor, my right hon. Friend the Member for Livingston (Mr. Cook), we now have a legally enforceable EU code of conduct on arms sales. More denials to China have taken place under that than have taken place under the embargo, and all but two of the denials under the embargo would have taken place in any event under the code of conduct.
	I hope that we will not make a decision on the lifting of the embargo at the European Council on Thursday and Friday. We need more time before putting all the arrangements in place. The European Council's general affairs committee agreed yesterday that we should seek a strengthening of the code of conduct, and also greater transparency between member states, to reassure everyone including our allies.
	I entirely agree with the right hon. and learned Gentleman's first point. I refer Members to an important passage in paragraph 194 of the report. According to the panel,
	"the international community does have to be concerned about nightmare scenarios combining terrorists, weapons of mass destruction and irresponsible States, and much more besides, which may conceivably justify the use of force, not just reactively but preventatively and before a latent threat becomes imminent."

Clive Soley: The Secretary of State will know that I am a very strong supporter of the UN High-level Panel and his efforts to publicise it, but can we make absolutely clear the importance of this debate to the future of the world? We need to understand that the United Nations has been and will remain in danger of becoming a second league of nations unless it can act more effectively against tyrannies in failing states, and in reforming the Security Council to make it more relevant to today's needs. This issue is of vital importance.

Chris Mullin: I would not wish to understate in any way the gravity of the situation in Darfur. The priority is to get the AU mission up to full strength and then to get it properly deployed.
	I continually hear reports of the situation in Darfur, often on the BBC, as if only one party—the Government of Sudan—were involved. In fact, there are two parties and, according to the UN Special Representative, Mr. Pronk, the rebel forces have been responsible for a greater number of violations than the Government side over the last two months. In October, the rebels were responsible for many ceasefire violations and in November, again according to Mr. Pronk, they aggressively violated their commitment to the Abuja protocols. It is important for people to bear in mind that there are two sides to the dispute. It is a very complicated one and both sides are behaving badly, but we do ourselves no service in improving our understanding of what is happening there if we continually pretend that it is all due to the Government of Sudan. That is not the case.

Denis MacShane: I pay tribute to our distinguished colleague and friend of all Members, my hon. Friend the Member for Walsall, North (David Winnick), who was present during the first election and contributed to the outlining of many aspects that had gone wrong. The UK is doubling the number of its observers for the re-run of the second round on 26 December. Our ambassador in Kiev informed me today that Terry Davis, our former right honourable friend who represented Birmingham, Hodge Hill—now the Secretary-General of the Council of Europe—was there yesterday. That will also contribute to the effort to ensure that the second round election is free and fair. Any hon. Members who would care to spend their Boxing day in Kiev should get in touch with me.

Iain Luke: My hon. Friend will be aware of early-day motion 273, signed by 116 Members, drawing the House's attention to the plight of Aung San Suu Kyi, who is currently in complete isolation, without telephone calls, and visited only by her daughter. Will the Government ensure that the ambassador in Rangoon continues to put the case of the House and the Government for an immediate release and do all that he can to ensure that Burma's neighbours in the Association of South East Asian Nations play a fuller part in securing the release of Aung San Suu Kyi?

New Clause 1
	 — 
	Excluded decisions

Mr. Speaker: With this we may consider the following:
	New clause 2—Excluded decisions (No. 2)—
	'(1)   Nothing in this Act authorises the withdrawal of palliative care.
	(2)   "palliative care" includes the provision of—
	(a)   relief of pain, suffering and discomfort;
	(b)   nutrition and hydration, however provided.
	(3)   The provisions of subsection (1) do not apply to—
	(a)   a decision that nutrition and hydration is to be discontinued because it would be unreasonably burdensome to the person; or
	(b)   the power of the court to make such order concerning the continuance of life sustaining treatment as it considers to be in the best interests of a person whom it has determined to be irreversibly unconscious.'.
	New clause 4—Palliative care—
	   'Nothing in this Act authorises the withdrawal of palliative care.'.
	Amendment No. 46, in clause 1, page 1, line 16, at end insert—
	'(7)   An act done, or decision made under this Act by any person acting in a professional capacity, or for remuneration, for or on behalf of a person who lacks capacity must:
	(a)   not be done in a way that is less favourable than the way in which it would be done or made for, or on behalf of any other person who lacks capacity, or for a person who had capacity, in a comparable situation,
	(b)   be done without prejudice to the person's age, sex, sexual orientation, disability, religious persuasion, racial origin, cultural and linguistic background and membership of any ethnic group.'.
	Government amendments Nos. 3 and 4.
	Amendment No. 1, in clause 4, page 2, line 4, at end insert—
	'(3A)   Where the determination concerns or affects the person's personal welfare, he must consider the person's life and health as basic to that welfare.'.
	Amendment No. 45, in page 3, line 3, at end insert—
	'(4A)   This must include the provision of communication support appropriate to the person, in particular in relation to the matters mentioned in section 4(5).'.
	Amendment No. 2, in page 3, line 3, at end insert—
	'(4A)   He must, where the determination relates to life-sustaining treatment, begin by assuming that it will be in the person's best interests for his life to continue.'.
	Government amendment (a) to amendment No. 2, in line 2, leave out 'best'.
	Government amendment No. 5, in page 3, line 27, at end insert—
	'(   )   "Relevant circumstances" are those—
	(a)   of which the person making the determination is aware, and
	(b)   which it would be reasonable to regard as relevant.'.
	Amendment (a) to Government amendment No. 5, in line 2, after 'determination', insert 'acting with due diligence'.
	Government amendments Nos. 37, 38 and 6.
	Amendment No. 32, in page 14, line 10, leave out clause 24.
	Amendment No. 42, in clause 25, page 15, line 5 at end insert—
	'and it was explained to P before reaching his decision that the withdrawal of the treatment in question might include the withdrawal of artificial nutrition and hydration.'.pa
	Government amendment No. 39.
	I call Iain Duncan Smith to move new clause 1. [Hon. Members: "Jim Dobbin."] I call Jim Dobbin.

Jim Dobbin: Thank you, Mr. Speaker.
	It is important to say at the beginning that there are several very important amendments that colleagues want to discuss, and time is short. It is therefore important that we get on with the debate and reach as many of those amendments as possible.
	Like many hon. Members, I welcome the Bill, which is long overdue and contains many good things that will benefit and protect those in a vulnerable position. As the Minister said, there has been genuine dialogue, which I have been part of, and some welcome changes have been made to the Bill, especially on clause 58, which makes it clear that the Bill does not change the law on murder, manslaughter or assisted suicide. I made that point on Second Reading, and it has been taken up.
	Nevertheless, I still have concerns. One danger that needs to be addressed is that clause 58 would inadvertently allow euthanasia by omission. I know that that is not, and never has been, the intention, and that euthanasia forms no part of the Government's policy. That has been made clear in many statements over the last few years. However, if the wording in this area were strengthened, the danger of euthanasia by omission would be averted.
	Unamended, the Bill would mean that those making proxy decisions to withdraw or to omit medical treatment could commit euthanasia without infringing clause 58. As it stands, if a proxy instructed a doctor to stop life-sustaining treatment, the doctor could do so with impunity because the purpose of his doing so would be to uphold the law which gives enforcement to the proxy's instructions. Even if the proxy had an unlawful purpose in making a decision to stop life-sustaining treatment, it would not be the proxy's decision that would cause death, but the doctor's action in withdrawing the life-sustaining treatment. Many proxies and decision makers would have been persuaded that because of the patient's feelings and values, death would be in the patient's best interests. They would argue that the lawful purpose of bringing about death by omission should be pursued. At present, under this jurisdiction only a court makes that decision and it is made only in rare and exceptional circumstances.
	Unfortunately, if unamended, the Bill would allow proxies and decision makers to withhold life-sustaining treatment, including food and fluid, and in numerous circumstances. That would not be a problem if all decision makers and proxies were influenced by the purest motives and sought only the patient's best interests, but we know that in some cases the motives of proxies may be their own self-interest. What is best for the patient could be replaced by what is best for the proxy. A doctor does not have to challenge the proxy's decision in court if he or she feels that the withdrawal of life-sustaining treatment is not in the patient's best interests: who then is going to protect the patient? If we adopt new clause 1, doctors will be able to resist a proxy if they think, in their clinical judgment, that continuing treatment would be in the patient's best interests.

Jim Dobbin: I agree.
	I shall conclude, because many Members wish to take part in the debate. For the record, I would like to make the purpose of new clause 1 crystal clear. In The Times today, my hon. Friend the Member for Knowsley, North and Sefton, East said that new clause 1 would leave doctors with no alternative but to keep people alive as long as possible. That is categorically not true. New clause 1 allows life-sustaining treatment, including assisted food and fluid, to be withdrawn in cases where it is futile or burdensome and where doing so would not interfere with good palliative care.

Iain Duncan Smith: I support new clauses 1 and 2. The hon. Member for Heywood and Middleton (Jim Dobbin) has set out a strong, factual case as to why the Government should support our proposal. I shall concentrate on only one thing, because there is a tendency to overcomplicate the issue. This group of amendments is at the heart of our debate today and we should consider whether or not, at the end of it all, we should withdraw food or fluids from people who would otherwise live. That is the critical point. The problem with the Bill is that it would give powerful legal backing to a certain interpretation of living wills. By the way, many Members may not know that a living will does not have to be a written document, and could result from a general conversation while watching a television programme which, like one shown in the United States, graphically depicts what happens to people who are in pain later in life. Someone might say to someone else, "Look, you are going to be my advocate. I do not want to be kept alive unnecessarily, and I do not want medical intervention to keep me alive." When the individual is incapacitated, their advocate can say that they made it clear that they did not want any medical intervention. However, the individual concerned would not have said that they wanted food and water, the most natural form of treatment, to be withheld. That is at the heart of our proposals which, as the hon. Member for Heywood and Middleton said, do not aim to overturn the Bland judgment.
	To make my position clear, I think that the Bland judgment was wrong. I have tabled amendments proposing that Parliament should make such decisions and not leave them to the courts. Why, after all, are we elected to the House if not to represent the interests of our constituents and make these decisions on their behalf, having discussed the matter with them? However, I am prepared to compromise, and I support new clauses 1 and 2, which will not reverse the Bland judgment, much as I would have liked them to do so. They make it clear that we should find in favour of life—that is the critical issue. Some people have asked for a definition of "burdensome". At the moment, however, the priorities are the other way round, and under the Bill it would be easy to withdraw food and fluids from an individual.
	Doctors and nurses in other parts of the world often disagree with the advocate's judgment. Some of them say that they can communicate with the individual, but their arguments have failed in court. That is the problem with the Bill, which removes the opportunity to reconsider what happens to a loved one. If the person concerned is conscious, even briefly, it prevents them from making a final judgment. That is the key issue. Many hon. Members on both sides of the House will agree that the hon. Member for Crosby (Mrs. Curtis-Thomas) spoke movingly about her experience when her mother died. If they have not already done so, I recommend that they read her speech, which makes it clear that if we should make a judgment in favour of life. If we persistently confuse medical treatment with administering food and water, we will find against life.

Frank Field: Does the right hon. Gentleman accept that we are not discussing the Bland judgment? That comes later, but it is important to make that clear. My hon. Friend the Minister has trotted out Age Concern and all those other great organisations, but how many of their representatives have living wills? The vast majority of our constituents do not have living wills in any form, written or unwritten.
	In considering the Bill, we are dealing with those who are incapable of making a judgment. What should the legal framework be to protect their interest? That is the judgment we have to make, but not for those of us who have decided that we want to go out of this world in a certain way. There is a case for debating that issue in respect of living wills and for honestly debating euthanasia, but there is no case for having euthanasia by the back door—withdrawing food and liquids from people when we are professing to doing something else.

Iain Duncan Smith: I can give the hon. Gentleman the assurance of a non-lawyer and of someone who, I hope, comes to the House with a certain amount of common sense. These new clauses were drafted so that that could not happen. If the Government think that areas of the new clauses would cause a problem, please come forward and help us to redraft them. Let us do that right now and vote on them, but they will not do that, as they seem almost scared stiff of any amendment to the Bill. We heard from the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), who said that Members of the House were all promised that amendments would be tabled. No such serious amendments have been tabled. The reason is that the Government do not want this area to be dealt with at all.
	I simply say to hon. and right hon. Members in all parts of the House that we have in front of us today a very serious question: do we make a presumption for life or a presumption that, in circumstances an individual may have their life ended, and assisted to be ended, by doctors and others who might be against such a presumption for life?

George Howarth: I wish to speak to amendment No. 2, which is in my name and that of the hon. Member for Tiverton and Honiton (Mrs. Browning), and new clause 4, which is in my name and that of several of my hon. Friends.
	Amendment No. 2 represents a genuine effort to build a consensus, which we hope addresses the key objectives that must be addressed if we are to resolve the issue. From the debate so far, I have a clear sense of what the House does not wish to condone in respect of patients who are in a coma or are otherwise incapacitated and unable to make a realistic or meaningful decision, who may be inappropriately subjected to invasive procedures to sustain or hydrate them in the last hours of their lives. Furthermore, I do not believe that we should in any way undermine the principle of advance directives, on which there is also some consensus, in terms of the circumstances in which those directives might be taken seriously. In that regard, the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) made an interesting point about a conversation held while sitting watching the television, but advance directives and the intent behind them should be judged more serious than that.

George Howarth: I thank the hon. Lady for that intervention. Just as the right hon. Member for Chingford and Woodford Green was inspired by my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas), it was a speech made by the hon. Member for Tiverton and Honiton (Mrs. Browning) in Standing Committee that set me off along this track. I will address exactly her point in a few moments.
	Many of the views expressed already in the debate reflect people's decency and straightforwardness in terms of how they wish to interpret the Bill. To be fair and honest, it is not reasonable to say that those qualities exist on one side of the argument but not on the other. Everybody is struggling to find a way through these difficult issues. In the course of trying to arrive at a form of words that makes some kind of sense, I sat through almost all of the Standing Committee, and consulted the British Medical Association and as many of the faiths groups as I could—some chose not to respond, for whatever reason—and I feel that there is a genuine wish in the House and elsewhere to arrive at a decent, straightforward conclusion, which reflects in the best way possible the many circumstances in which the provisions will have to be applied.

George Howarth: I have known my right hon. Friend for many years and have found that the best course of action with him is not to provide him with any advice, as he has his own opinions and arrives at them in his own way. I am confident that he has the intellectual capacity to work out his own position. What I would say, however, is that there is some merit in his argument. Earlier, we both took part in a Merseyside radio programme—we were not on the same programme simultaneously, but I had the benefit of hearing his contribution—and he made that point then. The climate is difficult, and we live in what people have referred to as a compensation culture. His concern is genuine and I am sure that if a distinguished medical practitioner says that it is a problem, we must take it seriously. I hope that my hon. Friend the Minister will address that point when he speaks later in the debate.

Andy Reed: On the point of consensus, it is clear that most people in the House would not want any form of euthanasia. For people such as me, who feel strongly about that, there is a certain amount of confusion at this stage about exactly what is being proposed. Having listened to my hon. Friend's contribution so far, I am looking forward to hearing more of it. I also have a great deal of sympathy with what the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) said, following our discussion earlier this morning. As my hon. Friend makes progress in his speech, will he enlighten us as to what he believes are the deficiencies of new clauses 1 and 2, and how his new clause would make the position much clearer, as many of us are genuinely struggling with this issue even at this late stage, despite the thousands of briefings that we have received from all parts of the country?

George Howarth: My right hon. Friend and I crossed swords in a slightly different context last night. I said then that I was always loth to enter into a disagreement with him, on two grounds: the ground that I have enormous respect for him, and the ground of self-protection.
	My right hon. Friend makes his own serious point in his own serious way, and I think it would be more appropriate for my hon. Friend the Minister to respond to it. I cannot take responsibility for my hon. Friend. I should be delighted to do so were he to ask me, but as he has never asked me I shall not.
	I have been trying for some time to make one or two general points about the amendment and the new clause before moving on to the more detailed argument. When I tabled the amendment, I was deeply conscious that I risked offending Members who have the same broad objectives as me, but wish to arrive at the same conclusion by a different route. To an extent, that risk has already been evident. I can only say that I recognise the absolute sincerity that those Members have brought to the debate, and hope they recognise that I am equally sincere. My disagreement with them relates not to their sincerity or objectives, but to how we can get to the best possible place. I believe that most Members, and most of the general public, want to get to the same place. The choice between the new clauses and amendments we are discussing is about how we get there. It is not that we want to be in different places; it is a question of which route we take.
	I hope that I shall not offend too many Members, because the hon. Member for Tiverton and Honiton (Mrs. Browning) and I are genuinely trying to build a realistic consensus. Like the right hon. Member for Chingford and Woodford Green I am not a lawyer, but I have some years' experience as a Member of Parliament. That has given me insight into the need for the language of legislation to be kept simple, and the need always to be alert to the fact that the more words we apply to complex moral issues such as this, the more the meaning of those words and the intention behind them can cause confusion and lead to misinterpretation. For those reasons, as I said earlier, I have gone to a great deal of trouble to consult those who take a strong interest in this matter, in the House and elsewhere. That includes my hon. Friend the Minister.
	I do not claim that the wording of amendment No. 2 and new clause 4 is perfect as it stands, but I believe it serves the objectives that I mentioned a moment ago. In what I considered a thoughtful speech, the right hon. Member for Chingford and Woodford Green said that he wanted to apply a simple test—to find in favour of life. I do not think that I have misquoted him. That is why, in amendment No. 2, I refer in terms to that very issue. The presumption in the amendment is that it is in a person's interests to stay alive—to be alive—rather than the alternative.
	I made the wording simple because I think it carries the spirit of the Bill with it. It adds a qualification to the "best interests" referred to in clause 1 (5). In other words, it is in the patient's best interests, in most circumstances, to stay alive. In my view, that gives a strong and clear signal to medical practitioners, and anyone appointed to act as a proxy or advocate, without giving them a set of instructions that in many cases they might be obliged to follow, even though they would not add to the comfort or dignity of the patient. Indeed, there will be cases in which the opposite will be the case.

Gordon Marsden: As was made clear at the start of the debate, a key issue is the ability of some advance decisions to be flexible. Does it worry my hon. Friend that in taking account of what the best interests of a patient might be, doctors and medical authorities might place too much emphasis on what might or might not have been said by that patient five or 10 years earlier? We have all heard the eloquent description given by my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) of the case of her mother, which is a classic illustration of why it is important to preserve flexibility. Does my hon. Friend feel that the wording of his amendment would allow doctors to make their decisions largely on the basis of the physical state of the person before them, rather than on what they might have said five or 10 years earlier?

George Howarth: If my hon. Friend will forgive me, I will not. There is a time limit and several Members seem to be indicating that I am taking up time that in their opinion, they should be able to use to express their views. For that reason, I shall not take any further interventions, and I shall move towards my conclusion.
	One of the strengths of the debate surrounding this issue has been the personal examples on which many people have been able to draw, not the least of which are the experiences that my hon. Friend the Member for Crosby described on Second Reading. Such experiences are difficult and emotionally wrought, and they have added to our understanding of what can go wrong, as well as what can go right. But we need to be conscious of the fact that it is very difficult to arrive at a general legislative proposition from particular examples. In fact, because each case is unique, it would be wrong to create a single template to govern an infinite variety of individual circumstances, and my fear is—I say this in as friendly a way as possible—that new clauses 1 and 2 do exactly that. They establish a set of instructions for people to follow in these very difficult circumstances. As the adage has it, hard cases make bad law.
	It was the hon. Member for Tiverton and Honiton who caused me to think further about this issue. Initially, I held the view that the "best interest" test, which first appears in clause 1(5) and subsequently in clause 4, was the right approach, in that it was sufficiently straightforward but also allowed adequate discretion as to what was appropriate in each individual case. However, the hon. Lady pointed out that in cases where hydration might not be appropriate, it could still be extremely uncomfortable for a patient to be left with a dry mouth, for example. Moreover, since such patients would probably be unable to communicate their discomfort, in many cases their need could be left unmet, either through lack of awareness—that is always a possibility in a busy hospital ward—or neglect, which is also possible. It was that concern that set me on this course.
	The British Medical Association tells me that this is a matter of basic care, which is normally down to good nursing practice. Thirst can be detected by a simple oral sponge test and remedied by proper oral care. I should make it clear that amendment No. 2 expects that such basic care be carried out in those circumstances.

Paul Burstow: I rise to speak primarily in support of my amendment No. 46, but also in support of the amendments and new clauses proposed by the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth). I shall also speak to support the proposals tabled by the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) that I have also signed.
	I want to make it clear from the outset that I do not believe that the Bill gives the green light to euthanasia. That is not just my view, but that of the Catholic Bishops' Conference, which said in its briefing to the Bill on Second Reading:
	"We had argued that the inclusion of a clause such as Clause 58 was the minimum required to provide the necessary assurance that nothing in the Bill permits euthanasia. With such a clause now in the Mental Capacity Bill, together with other important changes made to meet our concerns, we do not believe that the Bill can be described correctly as a Bill introducing a permission for euthanasia".
	That is an important and clear statement. Some of the press comments on the Bill seem light years away from the measured tone of the Catholic bishops. Some of the reporting over the last few days has been ill informed, misleading and, in going out of its way to frighten people, arguably mischievous. That is a real cause of concern.
	The Bill is about giving people who lack capacity greater control over their day-to-day lives.

Kevin McNamara: I am most grateful. The hon. Gentleman has cited what the Catholic bishops said. However, they also said that although clause 58 of the Bill could not be correctly described as introducing a permission for euthanasia, which would have meant opposition for that reason, it none the less still had two serious and remediable weaknesses. They said that, unless the weaknesses were addressed, the Bill could still unintentionally become a vehicle for euthanasia by omission or withdrawal of medical treatment.

Paul Burstow: The hon. Gentleman is right. That is why, in Committee, I tabled an amendment that was not dissimilar to the new clauses before the House today. It posed the question of the central purpose behind the action. Is it to hasten a person's death or is it to palliate and provide care, comfort and support? That is central to today's debate and I am clear in my personal view that the new clauses provide the additional reassurance that both the Church of England and the Catholic Bishops' Conference are seeking from the House today. That is why I started my remarks by observing that they have been assured on certain points, but the hon. Gentleman is quite right to draw attention to the fact that some further matters remain before the House today.
	As I was saying, the Bill is about giving people who lack capacity more control over the way they live their day-to-day lives. Understandably, our debate is focusing on end-of-life decision-making, but the bulk of the Bill is about the millions of people in this country who lack capacity to take decisions and it provides a proper framework in which they can take more decisions and exert more control over their own lives. It is about decisions as simple as what people eat, what they wear, when they go out and when they go to bed; everyday decisions that we in the House and many of our fellow citizens take for granted.
	The central purpose of the Bill is to maximise the opportunities for people to take such decisions for themselves. It enshrines in law a new starting point—a presumption of capacity—and only when it is proven that capacity is lacking can someone else start to take proxy decisions. Those outside the House who want to portray the Bill as somehow having an evil intention are doing a disservice to millions of our fellow citizens who will benefit from it. That, as well as the concerns of the Catholic bishops and others, needs to be put on the record.
	That does not mean that certain issues do not remain to be debated at this stage of the Bill or that the new clauses and amendments in the group would not help to further strengthen the safeguards. Indeed, the Bill will be strengthened considerably if they are passed today. I do not mean to imply that no further safeguards are needed in respect of such matters as advance decision-making. I believe that, as a general rule, they should be put in writing, but that is sadly not the case in the Bill as it stands at the moment.
	I want to make it clear that Liberal Democrat Members have a free vote on new clauses 1, 2 and 4 and on amendments Nos. 1 and 2. I will personally support new clauses 1 and 2 and will deal in moment with my reasons for doing so. The hon. Member for Knowsley, North and Sefton, East is right that people on all sides of the debate are trying to strike a balance and to find a way through and make it absolutely clear that the Bill is not about euthanasia. The best way of striking that balance is by testing opinion through free votes in the House. I regret the unwillingness in certain quarters to allow free votes on this matter. It reflects a weakness in the argument, but I appreciate that it is not the hon. Gentleman's fault.
	I want to speak to amendment No. 46. I believe that people have the right to expect that they will be cared for to the highest standards. The purpose of my amendment is to introduce an equal consideration clause into the statement of principles in the Bill. Such a clause would ensure that a person who lacks capacity is treated no less favourably than a person—any other person—who either lacks capacity or has capacity in similar circumstances. The purpose is to make clear that proxy decision-makers must banish their personal prejudices and attitudes when they come to act on behalf of a person who lacks capacity.

Paul Burstow: I am coming on to an example that addresses precisely that point. Sadly, that is what anecdotal and some research evidence suggests, so if we are putting in place statutory safeguards and arrangements for proxy decision-making, we must try to ensure that we avoid those pitfalls in future. That is what my amendment is designed to do. We should never make the assumption that life has less value for people who have difficulty in making decisions or need support to do so or who may not be able to make them at all. The adoption of the new principle would further increase confidence in the operation of the Bill.
	The amendment stems from evidence that has already been referred to and from anecdotal and other evidence that prejudices and attitudes about the quality of life of people with serious learning disabilities, serious mental health problems, head injuries or other conditions that affect capacity can get in the way of supporting those people as they are in respect of what they want and need. For example, decisions about treatment for elderly people or those with severe learning disabilities who lack capacity can sometimes be made by professionals on the basis that their lives are of less value than that of a much younger person.
	In other words, the date of a person's birth can determine access to treatment in a most unsatisfactory and inappropriate way. Such decisions can also be taken in a perfunctory way when it comes to consultation with families. There have been examples of families coming to visit an elderly relative in hospital to find a "do not resuscitate" notice hanging on the end of the person's bed without any proper dialogue with relatives or the individual in the bed about whether that was wanted. Amendment No. 46, therefore, will also complement families' new legal right to be consulted about the care and treatment provided to a relative who lacks capacity.
	In Committee, I raised a similar problem with the Minister, who argued that the Disability Discrimination Act 1995 and the Disability Discrimination Bill currently going through the House would provide protection for decisions and actions taken under this Bill. That may be so in many situations, but there are concerns that the Disability Discrimination Bill excludes a significant number of people who lack capacity. In particular, the requirement that a disability must have a long-term effect—and "long-term" is defined as a period of at least 12 months—will mean the people who lack capacity because of an illness or injury for less than 12 months will not be covered by the discrimination legislation currently going through the House.
	The Minister may say that such matters should be dealt with in the discrimination legislation, but I want to give the House an example. An older person who has an accident and loses capacity temporarily, but who is likely to recover, will still need professionals to make decisions on his or her behalf. Without the new clause as amended, there would be no protection for that person against prejudicial decisions based on age alone, especially if the person involved had no relatives to make representations. If the Bill makes no reference to discrimination legislation, it will create a lack of clarity for medical professionals and others about whether they are behaving in a lawful way.
	In the end, the courts will have to make decisions about the interface between this Bill and the Disability Discrimination Act 1995. Amendment No. 46 would close that gap and ensure that people are treated with equal consideration, regardless of capacity.
	I turn now to new clauses 1 and 2. The latest briefing from the Catholic bishops conference makes some important points. It states:
	"It is both moral and legal to withhold treatment when it is judged that the treatment, even if necessary to sustain a patient's life, is not in the patient's best interests because, given the patient's condition, the burdens it imposes are excessive compared with the benefits it offers . . . It is not true that life must be sustained at all costs . . . One can legitimately choose to forgo or withhold treatment because its burdensomeness is disproportionate to any likely benefit from it. One can do so even though one is sure that without it death will come soon, or come sooner."
	The new clauses recognise that reality. They accept that the courts still have jurisdiction in terms of making decisions. As the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) said, they do not change the Bland judgment, but they do prevent that judgment being extended by means of a statutory provision. The focus should be on whether the treatment is beneficial or burdensome, and the aim is not to keep a person alive at all costs. Hon. Members noted earlier that we should not strive officiously to keep people alive and, ultimately, such matters must be settled in the courts.

Paul Burstow: One concern mentioned in the briefings is that focusing on quality of life, and on whether a person's life is worthwhile, causes us to miss the point. We should ask, "Is this treatment worthwhile?" That is why I shall not support the amendment tabled by the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth), even though I know that it is well intentioned and attempts to bridge gaps.

Paul Burstow: I am grateful for that intervention, and I am sorry for his misunderstanding of my comments on the amendment.

Paul Burstow: I hope that the Minister will make it clear that the intention is to find a further amendment that will address this concern. I shall give way to the hon. Member for Tiverton and Honiton.

Paul Burstow: My anxiety is made worse by the fact that an amendment proposed to amendment No. 2 would delete the word "best", and water down the original in other ways. I accept that that is not the hon. Gentleman's doing, but that is the proposition before us today, and it gives rise for further concern.
	The amendments that I support are about clarity and reassurance. They are about ensuring that we are focused on treatment that is beneficial, not burdensome. We must make it clear that the courts still have jurisdiction in such decisions. Those amendments will be the subject of a free vote, but amendment No. 46 is about ensuring that regardless of whether someone retains capacity, he or she is treated in an equal fashion and is not the subject of prejudice, or bogus assumptions that lead to inappropriate treatment. That is the key to amendment No. 46 and I look forward to the Minister's response to it.

Brian Iddon: I speak in support of amendment No. 32, in my name and that of other right hon. and hon. Members. The amendment has the clear aim of removing advance directives, or living wills, from the Bill. I should say at the start that I do not belong to any pro-life organisations and I do not practise any religion actively, so I am not under any pressure from that direction. I am disappointed that we can have a free vote on beginning of life issues, but not on end of life issues. I would have preferred it if Labour Members had a free vote on this issue.
	I remind the Government that 102 Members of Parliament have signed early-day motion 336, which recognises that there is a problem with this Bill. I cannot vote for advance directives—sometimes ironically called living wills—to become part of our statute law, because they have always been abhorrent to me. However, to those who believe in them, I say that I have no objection to people making living wills provided that they remain in common law and are not enshrined in this Bill.
	I shall explain why I cannot vote to include advance directives in the Bill. First, we had a considerable debate on living wills when similar legislation passed through the Scottish Parliament. That resulted in the Adults with Incapacity (Scotland) Act 2000. The debate there resulted in similar clauses to those we are discussing being removed from the Scottish legislation. That is a significant point that we should remember. Secondly, the House of Lords Select Committee on Medical Ethics recommended in 1994 that advance directives should never be legally binding, as is proposed this afternoon. In paragraph 264 of its report, the Committee stated:
	"We suggest that it could well be impossible to give Advanced Directives in general greater legal force without depriving patients of the benefit of the doctor's professional expertise and of new treatments and procedures which may become available since the Advanced Directive was signed."
	The rest of the report contained similar comments.
	Thirdly, there is the uncertainty cast on advance directives by the recent challenge to them by Leslie Burke of Lancaster. The General Medical Council has appealed that decision and Parliament is awaiting the result, but it is pertinent to the decision that we will take this afternoon. Leslie Burke made the point that advance directives are very negative. One can ask the doctor not to do things, but one cannot ask the doctor to do things. That is the challenge by Leslie Burke and it is pertinent to our vote today. I cannot vote for advance directives when I do not know the result of that appeal.
	Fourthly and significantly, the twenty-third report of Session 2003–04 from the Joint House of Commons and House of Lords Committee on Human Rights, published as recently as 29 November, casts serious doubts on the Government's assertion that the Bill is compatible with human rights legislation. The Joint Committee believes that the Bill raises serious human rights concerns, which include putting advance directives in the Bill. It was not that long ago that the Government were against including advance directives in statute law. Why have the Government done a U-turn on that?
	I accept the good intentions of the Government in introducing the Bill, which has had a long gestation—about 15 years, in fact—and I am only sorry that the Bill has been spoiled by the failure to listen to its opponents. I am very disappointed that it came out of Committee unamended. Not a single principal amendment was accepted in the course of a fairly long Committee stage, and that concerns me.
	My fifth point is my real message: it is not what is in the Bill that counts, nor even what is left out of the Bill, but the signal that the Bill sends. I shall explain that by reminding the House of the origins of advance directives. They were launched in the United States of America in 1969 in a law journal article entitled,"Due Process of Euthanasia: The Living Will, a Proposal". That is the paper from which the subject of our debate arose. In 1977, a US Health Department official, Robert Derzon, advised President Carter to
	"change social values regarding cost-inducing activities".
	He continued:
	"The cost-saving from a nation-wide push toward Living Wills is likely to be enormous. Over one fifth of Medicare expenditures are for persons in the last year of their life".
	In 1991, the US Government made it compulsory for all patients admitted to a hospital, for whatever reason, to be presented with living will forms to complete. We might argue that that could never happen here. Well, it just has. In 2003, the Hammersmith Hospitals NHS Trust decided that it would offer living wills to all those admitted. It was followed by Imperial college hospital. Will that bandwagon roll further? Will the Government allow the NHS to give everyone admitted to hospital a living will? If someone is given a living will on entry to hospital, it puts them under pressure at a time when they are already sick and possibly depressed. What a time to give people a living will—as they are admitted to hospital. I condemn Hammersmith Hospitals NHS Trust and Imperial college hospital for that.

Brian Iddon: I do not know what Hammersmith Hospitals NHS Trust has in mind. I do not know the details of its agreement. However, I would be worried about it whether or not a relative filled it in. I am against the principle, which comes from the US.
	Is it any wonder that some of us link the Bill to euthanasia? In fact, the Voluntary Euthanasia Society and other organisations appear to be behind the move to enshrine advance directives in the Bill. If they are successful this afternoon, they will get a signal that the bandwagon is beginning to roll. There have been three attempts, including this one, by people such as Lord Joffe, to bring assisted suicide or voluntary euthanasia before Parliament. This Bill sends out the signal that the Government might—I emphasise the word "might"—be willing to listen to those people at some time in the future.
	Let us be fair to the Voluntary Euthanasia Society—it is, after all, one of the main propagators of living wills: its path is clear and if we do not know that, or cannot understand it, we should. Its path is to bring assisted suicide, or voluntary euthanasia, to this country, as has happened in the Netherlands, Belgium, Oregon and elsewhere. I am against that.
	The bioethicists march on. In a leading article, published in 1997 in the "Hastings Center Report", one of the pre-eminent journals on bioethics, Professor John Hardwig argued that there was a duty to die and published criteria to help people make that decision. I am horrified that in the Daily Mail this week, Baroness Warnock told the elderly something similar, under the headline, "Kill yourself, so you won't be a burden". That is reprehensible stuff. Where is the country going?
	People can change their mind. My hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) gave us an example when she talked of her mother. The respected journalist Claire Rayner signed a living will. Unfortunately, she had to go into intensive care where doctors could twice have switched off her life, but her relatives were not happy about it. I do not think that the doctors were happy either, but at the time living wills came under common law—not statute law. She survived and the first thing she did when she came out of hospital was to tear up her living will.
	At a conference in Holland in 1990, right to die groups pushed a pamphlet on living wills; on the back was the heading, "The Living Will: Passport to Euthanasia". If Members do not believe that people who push living wills will not be pushing assisted suicide or voluntary euthanasia next, they are living in cloud cuckoo land. That is why I am so against enshrining living wills in the Bill, and that is why I shall vote against it today, good as other parts of it are.
	At a meeting of the education council of the Euthanasia Society of America, a new document was proposed, whose stated purpose was to provoke a gradual change—a gradual change—in public attitudes to euthanasia. The author of the document also made a link between living wills and euthanasia. That is why some of us—perhaps only a minority—link the application of living wills under the Bill to euthanasia by omission, if not by commission. People who sign advance directives are usually convinced that they are taking greater control of their life, whereas in fact they may be giving up control of their life. That is one of the dangers.
	The concept behind an advance directive must surely be that the patient be allowed to die with dignity and in the absence of pain, yet by refusing some medical treatments the patient could suffer a lengthy, painful and bedridden existence, simply because they wanted doctors to carry out an advance directive.
	I am also concerned about the pressure that such provisions would put on the health service. The Minister wants people to obtain advice from their doctors, but are not general practitioners already hard pressed? How would such provisions operate in a hospital, especially in an accident and emergency department? How much bureaucracy will they pile on the NHS? If living wills are accepted in the Bill, more people will think, "They're a good thing, I'll make one, too". Relatives will start to talk. The whole process will gain momentum—the very thing the Voluntary Euthanasia Society wants. The more of them that are written, the more bureaucracy will be piled on the NHS. That is another reason why I am against enshrining advance directives in the Bill.

Tom Clarke: That is all the more reason why what the Minister has to say becomes profoundly important. I look forward to it.
	I will now make the brief speech that I wanted to make at this point. In most of the debates, including Second Reading, I concentrated my remarks on the parts of the Bill that dealt with advocacy. I hope to have the chance to speak on that aspect later. That did not mean that I was not interested in the end-of-life issues. I am profoundly involved in all the discussions that are taking place, especially in my constituency, where I have received many representations and people are anxious to hear what we decide today.
	The fact that I did not take part in most of those discussions in Committee did not mean that that was the position in Coatbridge and Chryston. I want to summarise what my constituents feel and what they expect from today's debate. It could become extremely complex. Indeed, very often in Committee, it did. We had opinion and counter opinion, but I supported Second Reading in order to give the Government the opportunity to clarify where they stood.
	I regret to say that I left Committee thinking that this was unfinished business on two crucial issues. That is why I am attracted to new clauses 1 and 2. I found very acceptable the views of my hon. Friend the Member for Heywood and Middleton (Jim Dobbin) and of the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith). Although we could make the matter complex, it seems to me, having listened to hours and hours of debate, that there are two issues that need to be resolved, two issues that call for clarity and two issues that do not seem to me to be intellectually demanding.
	On the issue of food and liquid—hydration and nutrition—have we made it clear that our priority is in respect of treatment and not of life? Have we made it clear that we are on the side of the patient until the end of his or her natural life? As this is all about perception, I want the medical profession to know where it stands. I do not want to see court case after court case. The obligation is on us to offer that clarity. That is one of two important issues on which simplicity invites itself. It is whether hydration and nutrition can be withdrawn legally—something that all of us, because we have said that we are opposed to euthanasia, do not want to see. We are entitled to an answer to that question. I am afraid that we did not get it during the whole process of consideration in Committee.
	The second point was raised at great length in Committee and in the Second Reading speech of my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas). What is the mechanism for taking on board the view of someone who, at an early stage in their life makes a written will, gives their instructions, signs an advance directive or gives some indication that they want to do so and later changes their mind? Those were the two crucial end-of-life issues, and they have not been resolved.

Kevin McNamara: My hon. Friend spoke for more than half an hour, but I hope to speak for less than 10 minutes.
	The Government's attitude makes nonsense of some Government amendments—for example, the amendment that would remove the word "best" from an amendment dealing with a person's best interests. We have an undertaking that these matters will be dealt with in the Bill, but regrettably that will occur in the other place again, not in this place, before the elected representatives.
	The Archbishop states:
	"I accept that the Bill as thus made more explicit will leave unaffected the jurisdiction of the Courts affirmed in the Bland case",
	so there is no change from that case. The right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) said that he would have liked to see that change and so would I, but that was part of the arrangements that were made. The undertaking that we have received is an important one.
	I therefore welcome the decision. It makes a good Bill a very good Bill. A Bill that would help us to look after and care for people less fortunate than ourselves was asked for by all the non-governmental organisations that care for people with mental illness or mental incapacity. Those requests have now been met. Removing the fear of euthanasia by omission, as the Government have now specifically and directly undertaken to do, and writing that into the Bill is an important step forward and to a large extent overcomes the major prinicipled objection that I and others had to the Bill.
	There are other matters to which the Joint Committee on Human Rights, of which I am a member, drew attention in its last report. The Committee wanted advance directives to be in writing. I hope we will get that. The Committee stated that
	"the classification of artificial nutrition and hydration ("ANH") as treatment may not be well known to lay people. The requirement that an advance directive specify the particular treatment for which consent is refused in advance should mean in practice that a specific advance refusal of ANH would be required in order to be effective."
	The Committee wrote to the Minister about that, and I hope the reply that we receive will address both matters.
	The undertaking given by the Minister seems to back the decision of the High Court in the Burke case. One wonders whether the Government are helping the General Medical Council in its appeal against that case. In respect of withdrawal of treatment where there is no advance directive, the Court pointed out that the guidance fell short because it seemed to accept that ANH can be withdrawn from patients who are not dying, if they are in a "very serious condition", and that it can be enough to justify withdrawing ANH from a patient who is not dying if it "may cause suffering" or be
	"too burdensome in relationship to the possible benefits".
	Important articles of the European convention on human rights are involved—article 2, on the right to life; article 3, on cruel and undignified treatment; and article 8, on dignity and privacy. The criticisms advanced by the Committee seem to have been met by the Government.

William Cash: The letter to which the hon. Gentleman refers mentions that the Bill does not authorise any decision where the motive is to kill. Will the hon. Gentleman compare the word "motive" with an alternative, such as "deliberate consequence"? Motive is a difficult matter to deal with. Does he agree that the words "deliberate consequence" might be better?

Kevin McNamara: That is a matter for the parliamentary draftsman. The Archbishop may be a distinguished social theologian, but he is not a parliamentary draftsman. I think the Archbishop and the Lord Chancellor know what they mean in this matter. The motive must be to end the life. The question has always been whether the withdrawal of treatment is to end the life, and not what is in the best interests of the patient and is not burdensome.
	On new clause 4, the failure of my hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) to define "palliative care" will give lawyers a field day, whereas new clause 2 makes it clear what is meant by "palliative care". Having seen the agreement that has been reached between the Government and Archbishop Smith, I will not vote against new clauses 1 and 2, but I will not vote for them because of the good will that I expressed to the Government for the undertakings that they have given.

John Redwood: Has my hon. Friend been given a copy of the text agreed between the Lord Chancellor and the Archbishop? Is this not a farce of a debate if we cannot have the words that the Government might want us to look at when we are arguing about other words, not knowing whether their amendment will be good enough?

Tim Boswell: I want to compress my remarks, but I shall come to the point that my right hon. Friend has raised.
	My second concern is the unwisdom of trying to force through a measure with inadequate time for debate. We could either oppose the programme motion, thereby wasting further time, or get on with it. With a little more consideration, we might have got on a lot better. If we had had the letter that enshrined an agreement reached by the Lord Chancellor with the Archbishop yesterday, which is now expressed in a letter from the Archbishop to the Lord Chancellor today, and if the Minister had at least been able to tell the House at the beginning of the debate three hours ago that he intended to speak to amendments along those lines, that would have been extremely useful.
	In response to my right hon. Friend the Member for Wokingham (Mr. Redwood), I must point out that there is no specific text yet. Anyone who has spoken, including the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth), who has gone to great trouble to try and hammer out consensus in the matter, has been hung out to dry by the very recent decisions that have been taken.

Tim Boswell: I entirely share the hon. Gentleman's sentiments. If only we had had the information three hours ago, we could have gone on to other concerning issues such as research and had more time to debate the Bill. However, let us not waste time on that now.
	The genesis of the debate lies in what might be termed the legal defence—the argument that the concept of "best interests" already exists in common law, that advance decisions are permitted under common law, that euthanasia is explicitly prohibited by law, which is enshrined again in clause 58, and that euthanasia should not be divided as between acts of commission or omission, both of which are unacceptable under law. That is agreed, but there is, nevertheless, concern about how the law works in practice.
	For a modern statement of the position, I refer the House to the judgment reported in The Times law report on 9 December, in which the Court of Appeal considered and upheld a judgment by Mr. Justice Coleridge in relation to a person who lacked capacity. Rather than reading out the text, I shall summarise: it is clear from that judgment, which was upheld, that the withdrawal of non-intrusive hydration or nutrition in the absence of either an unequivocal advance decision, which did not apply in that case, or any conclusion by the court either that the person was in a permanent vegetative state or that the continuation of life would be intolerable would neither be permitted under the present law nor sanctioned by the Bill.
	That comforts lawyers, but real world concerns exist. First, past practice has often been uneasy and, frankly, disturbing. Secondly—the hon. Member for Bolton, South-East (Dr. Iddon) spoke eloquently about this—there is a euthanasiast agenda, which must be watched all the time and is not acceptable to this House.
	New clause 1 would introduce a separate test from the treatment provisions in relation to purpose. Personally, I would have preferred it to specify "the purpose" rather than "a purpose". From what I have seen of the text that the Government are considering, the word "motive" may appear rather than "purpose". However, the plain fact is that if one is considering matters of deliberate killing, motive is important as well as delivery, which might occur through the withdrawal of treatment.
	New clause 2, which I have signed and find acceptable, would stiffen the requirement on treatment. The hon. Member for Knowsley, North and Sefton, East worked long and hard to produce compromise amendments, which would have been helpful if we did not have the full text. Liberal Democrat amendment No. 46 is also acceptable in principle.
	The interesting amendments have already been referred to. I give the Government some credit for the objective test of relevant circumstances. I hope that the Minister understands that my amendment to his amendment is designed to put the burden on the decision maker of taking reasonable care to ascertain the circumstances rather than simply saying that they did not know anything about the case and could not therefore have taken the circumstances into account. I hope that the Minister will reflect on that specific point.
	We have all piled in with additional safeguards. My safeguard would ensure that any person who signs an advance directive is, as the Joint Committee on Human Rights suggested, clearly apprised as to its implications for artificial nutrition and hydration. We await the Minister's response to the letter, which is due by tomorrow and has not yet reached the public. I also hope that he will consider the issue of instructions in writing—I cannot see why advanced decisions should not be in writing.
	I have compressed my remarks because the House has spoken for itself in its concern about those matters. We would all vote for greater and better safeguards than those so far offered by the Minister. This is not a good way to proceed and we could have saved ourselves a lot of time. However, the hon. Member for Knowsley, North and Sefton, East is right to say that it is better to get on with it now. If we get the matter right at the end of the day, the process will not concern us.
	We want further safeguards, which should not operate at the expense of the person without capacity. At the same time, they should not operate at the expense of either doctors or carers, because we do not want to create an unworkably intrusive system. We want to strengthen the Government's resolve and are irritated by the way in which the matter has been handled. The most important thing is to get the matter right for everyone concerned. We look forward to the Minister's response.

David Lammy: Yes, absolutely. Let us not forget that the Bill began 15 years ago under another Administration. We have continued the dialogue and have engaged in discussions with both my right hon. Friend the Member for Bristol, East (Jean Corston), the Chairman of the Joint Committee on Human Rights, and Peter Smith. Notwithstanding the detail on the purpose amendment, which we will get into shortly and which centres on new clauses 1 and 2 in particular, the Government are with the sentiment behind those new clauses, but the wording and intended consequences would cause some problems.

Jean Corston: The Minister knows the concerns of the Joint Committee on Human Rights, which I chair. We were particularly concerned about advanced directives. People who are required to sign advanced directives would have to say that they agreed to the withdrawal of treatment. We are concerned that they will not know that treatment includes artificial nutrition and hydration, which would put people, and sometimes their medical carers and families, in an impossible situation. Will he undertake to introduce measures to make sure that people give consent, that consent is independently witnessed and that the procedure is agreed throughout the medical profession? The consent should be in writing or, for people who are unable to write, some form that gauges intention.

David Lammy: I am grateful to my right hon. Friend, as is the Lord Chancellor, for our continuing discussions on this issue over the past few weeks. I can give her that undertaking. She will know that we put it in the code of practice, which has statutory power under the Bill. However, she has tried to see to it that advanced decisions in relation to life-sustaining treatment are covered by the Bill, and I can give her that undertaking on the basis of what her Committee has said.

Mike Hancock: On point of order, Mr. Deputy Speaker. Further to what you said about the letter to the Lord Chancellor being made available to Members in the Vote Office, may we have an assurance that if it is not available before the vote at 3.30, the Minister will read the letter to the House before he concludes his speech?

David Lammy: I will not give way.
	They will ensure that someone does not substitute their own decision for that of the patient. I hope that hon. Members will read amendments Nos. 4 and 5, which will ensure that the provision is more objective.
	On the purpose clause and on palliative care, it is important—I say this particularly to the right hon. Member for Chingford and Woodford Green—that others proposed an amendment that would rule out any decision made with the purpose of causing death. I assure the right hon. Gentleman that we have looked hard at that amendment, and we have continued to work on it, particularly with the Catholic Church, but the problem with it centres on the issues of palliative care and of purpose, in that the definition, as framed, includes artificial hydration and nutrition. That would contradict Bland. The right hon. Gentleman has been clear that he is against the Bland decision, but the vast majority of people, including the Archbishop himself, have sought not to overturn it.

Tim Boswell: On a point of order, Mr. Deputy Speaker. I have just sent messengers out to the Vote Office, which has indeed circulated further texts of the letter to the Lord Chancellor from the Archbishop. Apparently, however, it does not anticipate the receipt of any text of a letter from the Lord Chancellor to the Archbishop.
	In these circumstances, and given that there are 12 minutes left for debate, the Minister—if I can concede a point to him—will have some difficulty, however hard he tries, in explaining this without a text. All this has arisen because we are under a tight programme motion. I believe that it would be open to Government Front Benchers now to move an emergency modification to it. Will they reflect on that, because at least it would give us a little thinking time to try to get the matter resolved?

David Lammy: We have continued discussions and tried to meet hon. Members' concerns and the Archbishop has made his point and said—

Iain Duncan Smith: On a point of order, Mr. Deputy Speaker. We are about to vote on the new clause. I suspect that the Government have circulated the Archbishop's letter in the hope that many Labour Members will not vote. It is therefore critical that the Under-Secretary now reads into the record the undertakings that the Lord Chancellor has given to the Archbishop. Surely the Under-Secretary must give a guarantee that the undertakings will form a substantive element of the Bill when it goes to the other place.

Kevin Barron: There are some issues in the fifth report of the Shipman inquiry to which I take exception. In my five years on the GMC, I sat on fitness to practise committees for three years and I did not conclude that the GMC was soft on doctors. Nor was it the case that lay members felt differently about cases than the medical members of the committee. I hope that we will return to that issue in the future and I know that my hon. Friend the Minister will have discussions with the GMC about the implications of Dame Janet Smith's report. I would just say that in the past five years the GMC has had referred to it some 700 doctors, 500 of whom had findings against them on various levels of the fitness to practise procedures and 200 of whom were struck from the register. Those statistics do not suggest to me that the GMC is soft on doctors, so I dispute that point. Indeed, in its favour, Dame Janet did not say that the council had done anything wrong in 1976 when it was acting in the case of Dr. Harold Shipman. That was a bit before my time on the GMC—indeed, it was a bit before my time in the House.

William Cash: Indeed. I should be grateful if the right hon. Member for Rother Valley could tell me what would not be included under the provisions of the new clause. On my reading of it, there is virtually nothing that would not be included.
	The new clause continues with the words
	"will in the opinion of the Secretary of State".
	The words "in the opinion of" mean in law that, for practical purposes, there is no means of challenging the basis upon which the Secretary of State arrives at that conclusion. The new clause states that the procedure
	"will in the opinion of the Secretary of State not cause him"—
	that is, the person without capacity to consent—
	"significant harm and be of significant benefit to others."
	If that is presumed to mean that although not carried out for his benefit, the procedure could not cause him significant harm, and that that is intended to deal with the question of abortion, and to be of significant benefit to others, I would certainly take account of what the right hon. Gentleman says.
	New clause 3 is enormously wide. I cannot see much that would be excluded from it. I would be happy to hear that it is not intended to apply to abortion, among other things. In the light of what is contained in the Bill, I am rather concerned about what will happen once these issues have been taken out of the arena of the common law and the conventions and ethics of the medical profession, and transformed through statute and codes of practice into legal rules, which are enforceable and would need to be adjudicated. I am worried that there may be an attempt, driven by the profession and/or by insurers, to make sure that the buck is passed, making doctors and others in the medical profession less accountable than they are at present.
	There is an important question lurking in the back of my mind about all these matters. This is not intended as a criticism of a noble profession and the wonderful doctors, surgeons, consultants and so on, whom we know and trust. However, in the course of proceedings on the Bill, I detect a growing tendency that there is meant to be a change in the manner in which decisions will be adjudicated, just as, for example, we in the House have to form judgments on a daily basis about what we believe to be in the interests of our constituents. That is the duty that we have to discharge. Sometimes it is extremely difficult—in certain respects, it is difficult in the context of this Bill—particularly when conscience matters arise.
	My final thought is that just as it is intrinsic to our duties to arrive at difficult decisions on our own responsibility, which is one of the reasons why our deliberations are not constrained as if this House were a court of law, so the ultimate responsibility and accountability of doctors and others in those professions depends upon their judgment of what is or is not in the interests of their patients, which is a matter of the highest faith and duty.
	My hon. Friends the Members for Bournemouth, West (Sir John Butterfill) and for Tiverton and Honiton (Mrs. Browning) have referred to specific examples of clauses that depend on expressions such as "in the opinion of", and other examples include a case to which I shall return later in the debate. It is essential that we do not end up with broad-brush clauses, which I am sure are well-intentioned—I hope that they are well-intentioned—that carry grave problems of the kind that I have attempted to describe this afternoon.

David Heath: I shall be brief. The right hon. Member for Rother Valley (Mr. Barron) may have detected the lukewarm response to his new clause. We should not decry his intention, but he has not been sufficiently clear on the arguments why the patient's best interests should be set aside in such a wide range of circumstances.
	I shall not repeat points made by other hon. Members. I understand the right hon. Gentleman's point about diagnostic blood testing, but that case is already covered by the protection for the medical practitioner against any charge of assault or more serious harm. That is a clear example in which the interests of the individual are identical to the interests of the class—in diagnostic terms—of patients. For instance, it is not in an individual's interests to be barrier nursed as a precautionary measure simply because nobody knows whether they have a blood infection. It is possible to construct an argument in law on that basis, and if difficulties arise, we need a specific measure to deal with them.
	In my view—I do not want to labour the point—new clause 3 covers an enormous width of provision by referring to any medical or surgical procedure. Hon. Members have discussed sterilisation, which clearly falls within those parameters. I venture to suggest that the point raised by my hon. Friend the Member for Cheadle (Mrs. Calton) on testing drugs would also fall within those parameters.
	On transplant procedures, it would not cause a patient significant harm to lose one kidney, which happens all the time in familial relationships where that is the best match. Under new clause 3, could the Secretary of State require that a person should be operated on to remove a kidney for donation to another individual? It would certainly be of significant benefit to another person, but it would not cause the individual significant harm. No Secretary of State would make that assessment, but new clause 3 contains a width of provision that the House would be unwise to allow. The question has been put, "What possible procedures would not be included in that definition?" All I can think of are cosmetic surgical procedures, and even they could be said to be for the benefit of others. I hope that the hon. Gentleman will not in any way resile from his intention but will realise that the new clause is wrongly drafted.
	I want to raise one other issue in relation to Government amendment No. 7, although we have yet to hear the arguments for it and I do not wish to pre-empt them. It inserts into clause 31(2) the words,
	"or causes or contributes to",
	which means that the subsection will read:
	"The research must be connected with a condition which—
	(a)   affects P, and
	(b)   is attributable to",
	or causes or contributes to,
	"the impairment of, or disturbance in the functioning of, the mind or brain."
	I entirely understand why the Government wish to add those words—clearly, there are conditions that are caused by damage rather than being the cause of damage, and both should be included. The difficulty lies in the fact that the subsection deals with both mind and brain. When something affects the brain as an organ, there is clear cause and effect, but if mind is included, anything that causes or contributes to mental trauma could fall within the scope of the provision.
	That may not have been taken into account in the drafting procedure. I think that the drafters were trying to put right a lacuna in the existing wording, but by not recognising the difference between mind and brain they may accidentally have produced a rather wider sense to the subsection than they intended. I would welcome the Minister's comments on that specific point.

Dominic Grieve: It is that last point that bothers me. The others do not trouble me all that much. Even potential benefit might be a justification, but the nub of the issue is research carried out on an individual that is no possible benefit to that individual, but is justified on the ground that it is there for the wider public good. Are the Government comfortable with that set of ethical values?

Tim Boswell: This is a difficult argument, but I think that the principle is simple. Clause 1(5) makes a commitment that embraces the whole Bill; that acts done or decisions made should be in the best interests of the person involved. Is the Minister saying that that best-interests principle is suspended in the case of the research clauses? Yes or no?

Rosie Winterton: The hon. Lady is of course right. Some of these issues are covered in the Human Tissue Act 2004, so that we can be clear that such research can be carried out, with the proper consent.
	As I was saying, the difficulty is that it would be extremely difficult to ensure on every occasion that such research was in the best interests of P, so in effect, such a provision would prevent a great deal of research.
	Amendment No. 44 deals with an issue that was raised in Committee. I understand and share Members' desire to protect someone who may lack capacity from decisions taken by a court-appointed deputy whom they did not choose to represent them. However, the problem is that such a deputy might well know and be related to P; in effect the amendment would exclude a number of people who might be in the best position to know whether P would have wished to participate in such research. The court might well appoint a relative, friend or carer as the deputy, and we would not want to exclude such a person. However, I sympathise with the concerns expressed and we will amend the code of practice to make it clear that if a deputy has no relationship to, or knowledge of, P before their appointment, they should not be consulted on the question of P's participation in research. I hope that that deals with the concerns expressed.
	I shall deal briefly with the Government amendments. Some very useful suggestions were made in Committee and I agreed to look into them. We have tabled a number of amendments that draw on policy intention behind the various clauses. As drafted, clause 31 unintentionally prevented research into a condition or illness that causes incapacity, such as variant Creutzfeldt-Jakob disease or Alzheimer's, even where such research might be of benefit to P. As per our original intention, Government amendment No. 7 will allow research into anything that causes or contributes to P's condition, as well as anything attributable to it.
	Government amendments Nos. 8, 9 and 10 deal with removing a researcher's right of appeal. As was pointed out in Committee, as drafted clause 32 would give a researcher the right to apply to a court if a carer, friend or relative objected to P's taking part in the research. Frankly, that seemed rather unreasonable. If the carer or friend says that there should be no further research, there should be no further research and no further argument about it.
	Government amendments Nos. 11 and 12 deal with research in emergency cases. There were some concerns that the Bill as drafted was not clear enough about research done in emergency and acute medical settings. An example would be someone who had a head injury or stroke, for which swift treatment is often vital. There may be ways in which research could be done in relation to such treatment. Pumping someone's heart 15 times instead of 10 times in order to revive them might be relevant.
	Presently, it is unclear whether consent is required before such treatment can be carried out. The amendments clarify the point that the provisions apply to cases where urgent treatment is needed. I hope that that makes our intention clearer; that we do not envisage the provisions covering circumstances where a researcher just wants to act quickly. Rather, they apply to where people are suddenly incapacitated and the research relates to their particular condition at the time. Again, the research team would have to agree the specific detailed proposals with the research ethics committee before a trial could be approved.
	Government amendments Nos. 13 and 14 help to clarify the provisions on advance decision and the final amendments that we have suggested on research are also clarificatory. Clause 33 states that a researcher must not act in a way that is contrary to a person's advance decision. Amendments Nos. 13 and 14 make it clear that that applies to any earlier statement a person has made about not participating in research and is not limited to advance decisions as defined in clauses 24 to 26. If someone has said in advance that they are opposed to medical research and do not want to take part in it, the researcher must respect that and not enrol them in the trial.
	In conclusion, I understand that there are difficult issues surrounding research, about which hon. Members feel very strongly. People who represent those who lack capacity, including their families or carers, have made it clear that they feel it would be wrong to exclude people from being able to participate in and benefit from research, either for themselves or others. They feel that it would be almost discriminatory to introduce such a measure. What we have tried to do within the Bill is to balance that need against some very stringent safeguards. We in Parliament are able to lay down some of the necessary safeguards and, by working through codes of practice, implement them. I hope that hon. Members will withdraw their amendments and accept the Government ones.

Kevin Barron: I agree with the hon. Members for Bournemouth, West (Sir John Butterfill) and for Tiverton and Honiton (Mrs. Browning) about the extent of the powers that the Secretary of State could use if he were to bring in an order under new clause 3. It would be a brave and potentially foolish Secretary of State who wanted to deal with issues such as sterilisation or abortion by making an order, yet the new clause might well allow that to happen.
	My hon. Friend the Member for Stafford (Mr. Kidney), who is no longer in his place, was right to bring certain issues to our attention. He was absolutely right to mention the conventions and ethics that members of the medical profession adopt. They are always important when we are trying to bring into law, as it were, the legal rules that have developed under common law in recent years.
	I hope that the hon. Member for Somerton and Frome (Mr. Heath) was satisfied, as I was, by what the Minister said about diagnostic tests. I believe that the profession has a right to ask questions about that as we attempt to bring this law to the statute book.
	The hon. Member for Beaconsfield (Mr. Grieve) mentioned the use of emotive language. I would not use a phrase like "guinea pigs" in respect of the use of incapacitated people for research, and I would not condone the clauses on research if such language were used. However, in some areas it is vital to use people who lack capacity for research purposes. Such research must be carried out properly, but the benefits can extend beyond the person involved to other people who may suffer similar incapacity. An obvious example concerns people who lack capacity as a result of road accidents or head injuries. The effects do not always last forever, as people make progress with such injuries. I am no expert, but I am sure that the treatments and drugs derived from such research benefit others in similar circumstances. The medical profession wants people to know that there are legitimate reasons for conducting such research when the aim is to assist people who might in the future lose capacity because of similar accidents.
	I am sure that the BMA will be reassured by what my hon. Friend the Minister said in response to the concerns that it has expressed. I thank her for the clarification that she has supplied. The code of conduct offers more in the way of explanation about those matters into which research can be conducted, and I hope that the BMA will be satisfied with what she said.
	I beg to ask leave to withdraw the motion.
	Motion and clause, by leave, withdrawn.

Paul Holmes: New clause 5 continues a debate that occupied some time in Standing Committee. The Government propose to introduce independent consultees, along the lines of existing advocates, to advise NHS bodies and local authorities about what is in a person's best interests when a decision is being made about serious medical treatment, or before certain types of accommodation are provided. The Government also propose to provide £6.5 million to fund the arrangements, but only for persons without friends and family—the unbefriended.
	Much of that is good, as far as it goes, but concerns remain. The Making Decisions Alliance encompasses some 40 different disability campaigning groups and has been at the forefront in expressing those concerns. It said that what the Government call the independent consultee service could cause confusion by becoming a rival to the existing independent advocacy services and it believes that there is no need for two such services. That is why new clause 5 would replace all the references in the Bill to independent consultees with the phrase "independent advocates". Advocacy services already fulfil the role of independent consultees and make representations to decision makers. There is no need for a completely new service, with a completely new title to explain what it does.
	There is also concern about the restriction of the independent consultee service simply to the unbefriended. If the Government's advocacy plus, as Ministers dubbed it in Committee, is to involve highly trained, skilled and experienced staff, why deny their services to those people who have family and friends?

Question accordingly negatived.
	Amendment proposed: No. 2, in page 3, line 3, at end insert—
	'(4A)   He must, where the determination relates to life-sustaining treatment, begin by assuming that it will be in the person's best interests for his life to continue.'.—[Mr. Howarth.]
	Amendment proposed to the proposed amendment: (a) in line 2, leave out 'best'.—[Mr. Jim Murphy.]
	Question, That the amendment be made, put and agreed to.
	Amendment, as amended, agreed to.

Tim Boswell: This Bill raises immensely serious issues. All parties involved in the debate—and Ministers too, largely—have engaged in the effort required to put it into an acceptable state. As the Minister said, the Bill has had a 15-year genesis already. Hon. Members have worked together to achieve the common objective of assisting persons with mental capacity problems. We all recognise the sensitivity of the issue, and have searched for the appropriate safeguards.
	The case for the Bill was well expressed on page 27 of the recent report from the Joint Committee on Human Rights. The Committee states:
	"Our view on initial consideration is that the Bill should be broadly welcomed from a human rights perspective because it enhances the ability of people who lack capacity to make their own decisions where they can, and makes it more likely that sound decisions will be made on their behalf when they cannot make those decisions for themselves."
	That is a strong case for the Bill, but the Committee continues in the same paragraph:
	"A number of human rights issues arise, mainly concerning the adequacy of the various safeguards contained in, or envisaged by, the Bill."
	That warning is perfectly reasonable. The Bill will help by codifying the existing common law, for example in relation to advanced decisions. I was prepared to support the Government in the Lobby tonight on that, although I was not prepared to do so on other matters.
	I want to emphasise the safeguards that are required and, for reasons of convenience of reference, I shall follow the schema adopted by the Joint Committee. First, I turn to the matter of the Bournewood gap. My hon. Friend the Member for Tiverton and Honiton (Mrs. Browning) spoke characteristically powerfully about a matter on which the Minister said that he and his colleagues were still consulting. However, we need to deal with the problem promptly, and this Bill is the appropriate vehicle for that.

Paul Burstow: The proof of the pudding is in the eating. As we do not have the amendments, we do not know quite what we have achieved. I want to make clear why I shall support the Bill in the Lobby.
	As the Minister rightly said, the measure has been 15 years in the making, although some of today's comments were unfortunate, and the present law is confused and confusing. It allows people who lack capacity to be non-citizens; they lack rights and protections. It cannot be acceptable to leave the law as it currently is, which is why the Bill provides a necessary vehicle to give people far more control over their lives.
	The presumption of capacity is absolutely right. The principles set out at the beginning of the Bill have the potential to transform people's lives. They provide a framework in which those who act as proxies can, for the first time, take decisions with proper safeguards not only on health matters but also on welfare and finance. At present, those things are not clear and they need to be. The Bill provides the way to make them clear.
	We have strong support from Age Concern, the Alzheimer's Society, Mencap and many others who see the Bill as potentially transformative of the lives of people with learning disabilities, autism and Down's syndrome, but it is only a Bill with potential, as the Disability Rights Commission told us at Second Reading. There are still issues to be addressed and I hope that, in the other place, they will be.
	There is the question of equal consideration for those who lack capacity and those who have capacity. There is the interface with the Disability Discrimination Act 1995 and the Disability Discrimination Bill. There is the need further to strengthen the provisions to ensure that a person who may lack capacity is given every possibility and opportunity to communicate their wishes, needs and feelings. Supporting further communication in that respect is extremely important.
	We had some useful exchanges on the question of independent consultees. We need to ensure that we end up with a system that is advocacy-plus rather than advocacy-lite, so that we really widen the scope of the role of independent consultees; for example, the system should pick up people who are befriended. We could also address the question of whether "consultee" is the right name. The Minister may ask, "What is in a name?", but it is important to many organisations outside this place.
	The hon. Member for Tiverton and Honiton (Mrs. Browning) tabled some important amendments in Committee. I pay tribute to her for her work championing the closing of the Bournewood gap, but the mechanism is still not clear. Will it be the draft Mental Health Bill that she is scrutinising, or this Bill? We need that clarity and I hope that it will be forthcoming when the Mental Capacity Bill goes to the Lords. At present, people lack the safeguards they need.
	Advance decisions have been a key concern throughout the debate, and I welcome what the Minister said. If, at the very least, we are to codify advance decisions to refuse—as the Bill would do—they must be in writing. It is wrong that the Bill does not address that point and it should certainly be picked up in the other place.
	The Bill advances the rights of those who lack capacity and, if we manage to address these issues in the other place, it will improve people's quality of life whether they lack capacity from birth or as a result of illness or accident. The Bill has been 15 years in the making and there is still room for improvement, but it deserves a Third Reading to give it the chance of that improvement.

Kevin McNamara: I cannot go into the Lobby with the hon. Member for Sutton and Cheam (Mr. Burstow) because I am still confused. I am confused about what happened this afternoon; I am confused by what seemed to be given with one hand and taken away with the other. In fact, if there were a third hand, it would have been snatched away even further. I may be confused because of my age—I therefore have a vested interest in the Bill—but I am certain that my hon. Friend the Minister is not at one with the interpretation that the archbishop gave to his conversations and correspondence with my noble Friend the Lord Chancellor. I asked him whether the legislation in the other House would reflect Archbishop Smith's understanding as contained in his letter to the Lord Chancellor. He said that that depends on the amendments and on the lawyers, but he could not say yes.
	When my right hon. Friend the Member for Dumbarton (Mr. McFall) asked my hon. Friend the Minister whether the legislation would encompass the spirit if not the letter of new clauses 1 and 2, he answered in the affirmative—he said the same in his winding-up speech—but new clause 2 specifically contains the provision about nutrition and hydration. My hon. Friend the Minister seemed throughout the debate to be hung up on Bland. Rightly or wrongly, as the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) said, we may have lost the argument on Bland, but for the purposes of our argument today, Bland was out of the window.
	All the amendments specifically gave to the courts the right to decide the situation when people are in a permanent vegetative state, so that was outside the argument, but my hon. Friend the Minister spent a lot of his time discussing that issue, as though it were being attacked, when, in fact, none of the amendments were attacking that issue. So we came to the question in Archbishop Smith's letter. His interpretation was that acts of omission in relation to nutrition and hydration would be included in the new legislation in another place, and we have not had a specific reply to that.
	I said earlier that I would give the Government the benefit of the doubt on these matters, and I am still prepared to do so on Third Reading by not voting against the Bill, but my hon. Friend the Minister and the Lord Chancellor in another place should bear in mind that—whatever was agreed between the meeting of the parliamentary Labour party on Monday and meetings between the Lord Chancellor, the Prime Minister and other interested parties last night and undertakings given to Archbishop Smith—there is still an enormous question mark about what was and what was not agreed. Some of the things that my hon. Friend the Minister has said seem to be at variance with what Archbishop Smith seemed to suggest was said in his agreement with the Lord Chancellor. For that reason, I shall again abstain.

Iain Duncan Smith: I shall be brief; I do not have a lot of choice in the matter. May I simply say this evening that I am not convinced by what took place at the Dispatch Box during the debates on new clauses 1 and 2? I accept fully that the Minister's colleagues would have wanted to believe the best. That is the case in all parties—we want to believe the best of Governments and Ministers of our own party and accept them at face value—but I am reminded of the expression "A bird in the hand is worth two in the bush." I did not find a bird in the hand at the end of the debate; what I found were promises.
	With respect, the Minister has had weeks and weeks to come up with this. I recall that on the Hunting Bill the Government said that this place must make decisions and that the other place up the Corridor was not worthy of being relied on to make decisions. Tonight the Minister comes to the Dispatch Box and tells us, "Actually, we will do all the decision making in the other place because this place is not worthy of making decisions." I simply say to everyone in the House tonight that I cannot support the Bill as it stands right now.
	It being Seven o'clock, Mr. Deputy Speaker put the Question already proposed from the Chair, pursuant to Order [this day].

Gregory Barker: I start by thanking the Under-Secretary of State for Transport, the hon. Member for Staffordshire, Moorlands (Charlotte Atkins), not only for coming to the House this evening to answer my debate, but for the profoundly important decision that she made two weeks ago to allow the Bexhill link road to go ahead.
	A new route to join the A259 to the A21 is vital to my constituency and will reduce pollution and chronic congestion. The new proposal is on a smaller scale; nevertheless, it is a significant improvement on the old Hastings bypass. I know that the Minister had to examine the proposal carefully. However necessary any new road might be, important environmental considerations must always be weighed up. I am glad that she agreed with me and the vast majority of my constituents that in this case the benefits of the scheme significantly outweighed the costs.
	I know that the decision was a financial close call, as funding for new transport projects in our part of the country is limited, and the Minister had to turn down several competing projects. I am particularly grateful to her for taking the trouble to meet me and others from my area to listen to the arguments in person, before reaching her decision. Her courtesy and diligence will stand her in good stead as she climbs the ministerial ladder.
	The green light for the link road has come as a huge relief to my community. It is a major step forward in our endeavour to regenerate the economies of both Bexhill and Hastings, and with it to improve the life chances of so many local people. The link road is vital to the creation of new jobs and to the opening up of land to build sustainable homes for local families, and in so doing relieving pressure to build in villages in areas of outstanding natural beauty. First and foremost, the Minister's decision recognised that improved connectivity is crucial to the future of the whole area.
	It is almost unbelievable that at the same time as that historic decision to improve the road infrastructure of our area, the Government, through the Strategic Rail Authority, could even countenance axing the direct train service to Gatwick, East Croydon and London from Bexhill and significantly downgrading the coastal rail service.
	Earlier this year, the SRA published a document entitled, "Brighton Main Line, Route Utilisation Strategy", which has a nice picture of the clock at Brighton station on its cover. Richard Bowker's foreword to the document makes it clear that the document is primarily concerned with changes and improvements to the running of services from Brighton to London termini. Indeed, Mr. Bowker's foreword does not mention Bexhill, which gets a mention only towards the end of the executive summary.
	The report states:
	"there are a small number of disbenefits of the strategy compared with today's level of service".
	The third bullet point on page three states:
	"In order to deliver better performance across Eastbourne, and to reflect the local nature of the market between Eastbourne and Hastings, the through service from Hastings and Bexhill to London (via Gatwick) is now proposed to start and terminate at Eastbourne."
	That seemingly innocent afterthought to this completely Brighton-centred document would in fact have a devastating effect on the town of Bexhill were it allowed to be implemented. The psychological impact alone would be enormous. The net result of the proposal would be to lengthen the journey time to London and increase the scope for significant delays. Most importantly, however easy the SRA endeavours to make a platform change, the inescapable necessity of changing trains will have a profound effect on every passenger's willingness to use the train service.
	I appreciate that the principal aim of the route utilisation strategy is to improve performance, but there is very little in the SRA proposal that would be regarded by my constituents as an improvement, and a very great deal that would be seen as highly damaging. The whole town of Bexhill has been united in condemning these proposals, which saw the light of day only at the very end of the statutory consultation period.
	Opposition to the plans goes right across all political party boundaries, and they have been strongly criticised by Rother district council, Hastings borough council, East Sussex county council, the Bexhill town forum, the Bexhill chamber of commerce and the Hastings and Bexhill taskforce, on whose board I sit and whose other members include the South East England Development Agency and the Government office for the south-east. I want particularly to pay tribute to the energetic campaign of Rother district council's lead cabinet member for transport, Councillor Ian Jenkins, who was one of the first to spot the dangers that the proposals pose to Bexhill.
	The impact on the town would hit trade, tourism, commuters, elderly passengers and students. I shall deal briefly with each of those groups. Many commuters have written to me to make clear their objections to the scheme, but none has put their case more articulately than my constituent, Mr. John Cormode, a management consultant residing in Bexhill who specialises in change management and business research. In a letter to the SRA, he wrote:
	"I was absolutely appalled to learn that the SRA is actively proposing changes that will cause a further considerable deterioration in the train service for customers between Bexhill and London, in a Government regeneration area.
	By abolishing the only direct rail link between Bexhill and London, making passengers change at Eastbourne, will add at least 30 minutes to the journey time—assuming the connections always work. If the connections do not work we can look forward to adding at least an hour and a half to the journey time! I am a season ticket holder from Cooden Beach to London and the daily journey time each way already takes 2 hours . . . it would be quicker to travel to Darlington or Brussels than Bexhill! The service will particularly deteriorate for the journey home, when there are even fewer trains from London to Bexhill than in the morning. At Cooden Beach up to 12 passengers regularly use the 0635 service—all of us will now not reach London until after 9 o'clock with further journeys to our place of work on top of this.
	The excuse that 'new' rolling stock is not compatible with the 'old' does not mean that these changes need to be made. You find it possible now to run 'new' rolling stock trains to London at 0635 and an 'old' rolling stock train for my journey home. To avoid inconveniencing your customers and to encourage the use of public transport all you need to do is to continue to run the complete trains of either old or new stock until you have enough of the new to withdraw the old, without compromising the service to commuters.
	Your proposals make even less sense at a time when central and local government, all the regional agencies and local business groups are doing everything possible to regenerate Bexhill and the surrounding area. I can think of no other single act by an agency like yourselves that will ensure that these regeneration plans and the local economy goes rapidly into reverse. The £6 million spent on creating the biggest arts centre in the South East at Bexhill, the funding of the University Centre in Hastings, or improving Bexhill and Cooden railway stations will not lead to regeneration if the SRA's proposals mean that they make it very much more difficult for the public to reach them, or people to visit, live and work from Bexhill."
	The Bexhill town forum has been equally vociferous in its opposition to the proposals. Mrs. Margaret Jones has made the forum's concerns clear to the SRA, reflecting its unanimous vote on 30 November to oppose the SRA's plans. The forum is particularly concerned about the effect that the loss of a direct service from London will have on the De La Warr pavilion. The De La Warr will reopen next year, after an extensive refurbishment, as an international arts centre and the biggest contemporary art gallery in the south-east of England.
	It is estimated that 50 per cent. of its visitors from outside Bexhill will reach the De La Warr by train. In 2001, the De La Warr attracted 500,000 visitors, of whom 75,000 came directly from London. In 2005, the refurbished De La Warr is expected to attract more than 750,000 visitors, of whom 150,000 are projected to come from London. The De La Warr Charitable Trust told me that
	"we are preparing a programme of National Work to encourage people from London and the suburbs to visit. These are events and work that will not be seen in London. We aim to produce world class programmes for a national audience. Any disruption in transport would have a severe impact on our ability to attract a national audience."
	Imagine if Glyndebourne opera house, which successfully attracts a large audience who travel by train every year, had to tell opera goers taking the train at Victoria that they needed to change halfway through their journey. It would fundamentally undermine their ability to operate.
	We must not overlook the elderly population in Bexhill, who depend on the train service, especially its direct link to Gatwick airport. Bexhill has the second largest pensioner population in Britain and the highest proportion of over-80s in the south-east. The prospect of changing trains with suitcases and luggage would be a profound deterrent to those who do not wish to take the car to the airport.
	It is also vital when attracting new businesses into our area as part of the regeneration initiative that not only Bexhillians should enjoy direct rail access to Gatwick but foreign visitors landing at the airport should be able to enjoy direct rail access to Bexhill. The public transport policy officer at East Sussex county council rightly pointed out that the proposals are not only about cutting a direct link to London but proposed cuts to the volume of services. Pevensey Bay and Cooden Beach station would lose one service to London an hour, and the very existence of Collington and Normans Bay stations could be threatened.
	I should like efforts to be made to encourage more people off the roads and on to the trains. The proposals would have the opposite effect. The cuts, together with previous changes, have not happened anywhere else on the network on such a scale. Transport professionals have serious concerns about the proposed connection at either Eastbourne or Polegate. Previous promises about connecting trains from Brighton to Hove have not been kept and it is clear that a train coming along the coast would not wait for a delayed service from London, leaving Bexhillians who were travelling home absolutely stranded.
	I summarise by saying that the ill-thought-through and poorly researched proposals would have a devastating effect on Bexhill. They would drive more people on to the already crowded roads of East Sussex. Mr. David Getty, the president of the chamber of commerce and tourism in Bexhill, said:
	"The reduction in service levels resulting in the abolition of a direct rail link from Bexhill to Gatwick and London will seriously hinder attempts to regenerate business in Bexhill. At a time when the local public and private sectors are working closely together to secure investment for a range of regeneration initiatives their success is jeopardised by the decision to downgrade Bexhill to a town with no direct rail link to London.
	Major local employers in the fields of insurance and education, particularly those teaching English as a foreign language, will suffer through the loss of the direct link, particularly to those towns competing for this business which do have a direct link such as Eastbourne and Hastings"—
	and Brighton. He continues:
	"The roads around Bexhill are already congested and the effect of the proposed changes will be to send more commuters, theatre-goers and tourists"—
	and students—
	"onto the roads. They will not risk the uncertainty of changing trains at Eastbourne—where there are already regular instances of delays due to lack of connecting stock or drivers . . . they will simply travel by road to Polegate or Battle to join London trains from Eastbourne or Hastings respectively.
	The SRA has said that 'it cannot fund assistance towards regeneration'—no one is asking it to do so; but it should not be permitted to threaten regeneration without the clearest of compelling financial data. The SRA has not come close to meeting this basic requirement: it has been unable and unwilling to state how many people use the direct train under threat"
	using ill-thought-through numbers.
	The SRA proposals take no account of the projected growth in population of Bexhill, which will follow directly as a result of the Minister's historic announcement two weeks ago, nor of the projected growth in visitors to the area as our economy regenerates and tourism revives. The SRA proposals are simply a formula to run down our railway to a point where it could lose a critical mass of passengers. If that were allowed to happen, the inevitable logic of the SRA's arguments is that the line would be likely to close altogether in the years to come. The SRA, in a letter to me of 8 December, said:
	"We accept that changing trains will inconvenience through passengers and discourage people from making these journeys. We also accept your comments that this would have an adverse effect on the local economy."
	It went on to say that
	"the SRA is not responsible for prescribing a holistic provision of transport services for an area."
	If joined-up thinking on transport is not the remit of the Strategic Rail Authority one wonders why it bothers to include the word "strategic" in its name. Such thinking, however, is the responsibility of the Government, the Department for Transport and every transport Minister. I therefore make a plea to the Under-Secretary, who has shown good judgment to date. I urge her in good faith to intervene and direct the SRA to step back from these destructive proposals, and safeguard the benefits for Bexhill and the surrounding area, as promised by her historic decision two weeks ago.

Charlotte Atkins: I congratulate the hon. Member for Bexhill and Battle (Gregory Barker) on securing this debate, thus providing an opportunity for us to discuss rail services to Bexhill. I thank him, too, for his kind remarks about the approval of the link road a few days ago.
	Bexhill is currently served by the Brighton to Hastings stopping service, which runs at a frequency of two trains an hour for most of the day on Mondays to Saturdays. An hourly direct service to and from London Victoria runs seven days a week. It is also possible to travel to Ashford, destinations along the south coast and other London termini such as Charing Cross, Waterloo East and London Bridge by changing at Hastings, St. Leonards, Warrior Square and Brighton. At present, those services use a mixture of mark 1 slam-door rolling stock and modern air-conditioned rolling stock. Most of the older rolling stock will be replaced by the end of 2004, and all of it will be replaced by mid-2005. The performance of the services that serve Bexhill are measured by the public performance measure published by the Strategic Rail Authority in "National Rail Trends". In the past year, 81.8 per cent. of trains arrived at their destination at the time shown in the timetable or within five minutes of that time. By comparison, the figure was 84.6 per cent. in the previous year, and 84.5 per cent. for all London and south-east commuter service operators. The slightly lower level of performance this year, especially when compared with that of similar operators, can be attributed to the teething problems of the new rolling stock and the growing unreliability of the mark 1 slam-door trains, which are being replaced.Most of those teething problems have now been overcome, certainly in the operation of trains, although further work on heating and air conditioning systems is still needed. Clearly, that does not affect train performance, although it does affect quality and thus passenger satisfaction with train journeys. When all the new rolling stock is in service it is expected that train performance will improve.
	On the SRA's Brighton main line route utilisation strategy, it clearly aims to improve the performance of train services and ensure that optimum use is made of available train and network capacity. We have set the SRA tight affordability constraints, and it must demonstrate that any changes are financially robust. It proposes that one stopping train an hour between Brighton and Ore will call at Bexhill, and one fast train an hour from Brighton to Ashford will also call there. Two trains an hour will operate between London Victoria and Eastbourne. They will run up to ten minutes faster, but they will not serve Bexhill directly. Passengers from Bexhill who wished to travel to Gatwick airport, East Croydon and London Victoria would have to change at either Eastbourne or Polegate.
	The level of service from Hastings and St. Leonards to London Bridge, London Waterloo East and London Charing Cross via Tonbridge is not affected by the Brighton main line rail utilisation strategy proposals.The SRA accepts that changing trains will inconvenience through passengers and risks discouraging people from making their journeys by rail. It is, however, working on making the connections between the Ashford to Brighton and the Eastbourne to London train as seamless as possible. By changing at Polegate, passengers would not have to cross the footbridge. They would alight from the train, wait on the platform and board the following train. The direct train service from Bexhill to Lewes would be reduced to two trains an hour, rather than three, but the direct link to the county town would be retained.
	One of the SRA's reasons for reducing the train service east of Eastbourne is the low level of patronage. The figures for travel between Bexhill and London—both Charing Cross and Victoria—suggest that there are, on average, approximately eight people per train travelling in each direction from Bexhill to London. Some of those passengers are presumably going via St. Leonards, so the number using the Brighton line service to Victoria is fewer than eight per train. In total, about 12 people per train travel from stations between Eastbourne and Hastings to stations on the Brighton main line, so in practice those are the only people who will be inconvenienced by the SRA's proposals for changes to the service.

Charlotte Atkins: I thank the hon. Gentleman for clarifying that. If he wants to bring the point about season tickets into the equation, it may well help to boost the low usage figures. I appreciate his point that average figures obscure the reality of the journeys that individuals make, which may change from time to time, from season to season and from train to train, but the figures that I gave suggest that the SRA is right to consider the impact that the suggested change to the service will have on a relatively small number of people. If he has additional information or evidence, he should allow the SRA to see it.
	We understand that any direct service that is replaced by a connecting service might suffer a passenger reduction, but I think that the hon. Gentleman would agree that resources must be focused in the most effective way to improve the overall financial position of the railway. The proposals will also relieve congestion at Hastings station.
	One of the main recurring points relates to the effects of the Brighton main line route utilisation strategy proposals on the demography, economy and regeneration of Bexhill and Hastings. We are aware that significant regeneration efforts are being made—the hon. Gentleman mentioned the link road, where the issue of regeneration was clearly crucial and the De La Warr pavilion is being reconstructed—to encourage significant numbers of visitors to travel to the area by train.
	It has also been mentioned that it is desirable that links to educational and arts establishments are provided and it has been suggested that there is the need for direct access to the transport and business hubs of Gatwick airport, Clapham Junction and East Croydon. Any route utilisation strategy is focused on improving performance and better use of track and train capacity, within the constraints of affordability. The SRA—this is reflected in its appraisal guidelines—examines only measures which might be taken to improve the efficiency and viability of the railway.

Charlotte Atkins: Obviously, the regeneration effects of rail are significant, but there is a direct route from Hastings which, as I know from our discussions, is not too far from Bexhill. Such routes are available and many people will choose to use them. I do not underestimate the effect of the inconvenience for those passengers who use that route, but given that there are direct services from Hastings, it is not an impossible journey.
	The SRA met several local stakeholders affected by the Brighton main line route utilisation strategy proposals before the consultation document was launched. Those meetings were generally at the county council or regional assembly level. The SRA noted the apparent lack of information dissemination by some of those stakeholders, which it recognises as a problem, and that will be addressed directly with stakeholders in all future SRA work.
	We have given directions and guidance to the SRA to develop the capacity of the railway, both of the trains and the network, so that they are both utilised to the maximum. In doing so, it must have very strong regard to the cost-effectiveness and affordability of services. We are not seeking to close any stations or lines, but we are aiming to rationalise services, which may mean that some previously through services will now involve a change of trains. The SRA is working to ensure that those changes are as smooth and trouble free for passengers as possible, as it and we are aware that some passengers are actively discouraged from using trains if they have to change. We hope that the increased punctuality and reliability of services and the reduction in journey times, even including the time taken to change trains, together with the new modern rolling stock fleet, will encourage existing passengers to continue to use trains and encourage others to do so.